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NIMH Affective Disorders Workgroup

Publications and source records attributed to NIMH Affective Disorders Workgroup.

13 recordsLinked to original sources
PubMed2002

Barriers to reducing burden of affective disorders.

This paper summarizes 3 sets of barriers to reducing burden of affective disorders including factors that contribute to 1) the risk, course, and outcomes of affective disorders; 2) help-seeking and use of health and mental health services for affective and other mental disorders; and 3) the appropriateness of treatments used for affective disorders. On the basis of this review, the authors recommend research needed to identify modifiable barriers to reducing the burden of affective disorders and to identifying opportunities to reduce these barriers. This new research should focus on clarifying societal, family, and consumer, clinician, and system barriers to recognizing disorders, seeking and providing care, and adhering with guideline concordant care, and should include barriers that apply to both treatment and prevention services.

Comorbidity↗
PubMed2002

Community-based interventions.

This paper explores the potential of community-based, public health-oriented interventions as a tool for reducing the burden of affective disorders on individuals, their families, and communities. The paper reviews the use of community-based interventions with other health-related problems and describes potential applicability for affective disorders such as changing public attitudes, reducing social stigma, facilitating access, or supporting treatment adherence for populations in their community settings. An agenda for developing this field of intervention research is proposed.

Community Mental Health Services↗
PubMed2002

Research on reducing burden of affective disorders for special populations: introduction and general recommendation.

Populations should be prioritzed for research on reducing the burden of affective disorders based on expected or known burden or current level of unmet need for care. We recommend a focus on ethnic minorities, impoverished women, children, adolescents, and individuals with bipolar illness. Studying effectiveness of interventions and the efficiency of delivery systems are priorities for special popultions.

Adolescent↗
PubMed2002

Ethnic minorities.

Ethnic minorities have relatively similar rates of mood disorders as do white Americans, but they are much less likely to receive appropriate care. Barriers to care include lack of insurance, few minority providers' racism, and distrust of care providers. A priority in research is identifying practice interventions and policies that could eliminate disparities in care.

Cost of Illness↗
PubMed2002

The elderly.

Late life depression is common and associated with disability, reduced quality of life, mortality, and high health care costs. Depressed older adults frequently have comorbid medical illnesses and cognitive impairment, but relatively little is known about the diagnosis and treatment of depression in the face of these comorbid conditions. Only a minority of depressed older adults receive specialty mental health care and most depression care is provided in primary care where few receive effective treatment. Very little is known about the epidemiology and quality of care for bipolar disorder in late life. Additional research should focus on the quality and outcomes of care for older adults with affective disorders in diverse settings (including primary care, specialty mental health care, home health care, nursing homes, and assisted living facilities) and on the care of older adults who have affective disorders and comorbid medical disorders, dementia, substance use disorders, or chronic pain.

Aged↗
PubMed2002

Research development mechanisms.

Studies designed to reduce the burden of affective disorders should apply and develop theories and methods from diverse social sciences that could strengthen current interventions. A series of papers from diverse fields, such as quality engineering, behavioral economics, etc. might be a needed first step. Methodological research on design strategies such as group-level randomized trials, or instrumental variables analyses are needed. Finaly, qualitative studies to understand diverse stakeholder views are also needed. To pursue these areas, interdisciplinary training programs are needed to develop skilled researchers to study communities and community-based delivery settings. New research infrastructures are needed to support community and research collaborations, as well as supporting development of new technologies to enable diffusion of care.

Cost of Illness↗
PubMed2002

Burden of illness.

The burden of affective disorders includes costs and the pain and suffering of affected individuls. Burden can be perceived from social and private perspectives. Although no ideal measure of burden exists, ample evidence documents the extensive cost and other negative impacts of affective disorders. Affective disorders are associated with disruptive family relations, higher health care costs for comorbid conditions, elevated rates of suicide, and lower productivity. Reserch should focus on improving measures of burden in general and on quantifying burden from the standpoint of diverse population groups.

Cost of Illness↗
PubMed2002

Practice-based interventions.

Current evidence indicates there remains a large gap in the provision of depression care, particularly in primary care. Several studies have demonstrated that interventions based on the chronic disease management model can improve patient outcomes. Challenges include designing more robust interventions that can move easily into a wide variety of primary care organizations. More research is needed to develop programs to improve outcomes for children with depression and adults with bipolar disorders.

Adult↗
PubMed2002

Policy intervention.

This paper addresses market failure due to externalities, as well as information asymmetries and public policy problems that need to be solved to ensure high quality care for affective disorders. We delineate the problems in parity legislation, managed care, as well as Medicare and Medicaid that need to be addressed to reduce the burden of illness affective disorders. A research agenda is developed for formulating and implementing public policy.

Cost of Illness↗
PubMed2002

Bipolar disorder.

Manic-depressive (bipolar) disorder is a severe, relapsing mental illness that shares characterstics both with major depressive disorder and with serious mental illnesses such as schizophrenia. Like schizophrenia, it is a chronic disorder, and is treated primarily in the specialty mental health sector. Rates of appropriate treatment are low. Functional outcome is compromised for the majority of individuals who have this disorder. Societal costs are exceeded only by those for schizophrenia. Existing cost calculations likely underestimate societal costs because of underestimating functional impact and neglecting to account for the substantial proportion of individuals who are institutionalized outside of the health care system (e.g., in prison). Little is known as yet regarding manic-depressive disorder in historically underserved groups and in vulnerable groups such as the elderly. There are major lacunae with regard to this disorder in the grant portfolios of all federal agencies mandated to address the needs of Americans with serious mental illnesses. The authors in the context of the Wider NIMH Affective Disorders Workgroup propose several specific recommendations to address the needs of this costly and underresearched disorder.

Bipolar Disorder↗
PubMed2002

Children and adolescents.

Until the 2001 Surgeon General's report there had been no acknowledgment of the need for a national plan for research priorities to improve services and reduce illness burden for children and adolescents with severe mental disorders. Barriers to services among those in need include individual and family factors, and clinician and service system factors. Additionally, little reserch is available on the impact of major policy reforms on children's ability to obtain efficacious care. Critical research gaps exist in a number of areas with the prevention and early intervention area representing a particularly important missed opportunity.

Adolescent↗
PubMed2002

Gender issues and socially disadvantaged women.

Gender differences in overcoming barriers to mental health care for affective disorders have not been studied. Further, the role of mental health care for parents as it affects child outcomes is important but currently not well studied. In particular, care for disadvantaged young women is an area in need of further research.

Cost of Illness↗